1. Set standards for the implementation of syndromic STD case management at all levels of health care.
   
   

2. Define roles, functions and requirements in the provision of STD services at all levels of health care.
   
   

3. Establish the referral system of STD case management.
   
   

4. Provide reporting mechanism at the different levels of care.
   
   

5. Set the extent of care and technical boundaries that can be provided at the different levels of care.

Administrative Order No. 2 s. 1997, on the National Policy Guidelines for the Prevention and Management of Sexually Transmitted Diseases (STDs) was issued to be the basis for the provision of STD services at all levels of health care system nationwide in order to decrease prevalence, complications, consequences and reduce the spread of HIV. As provided for in the order, the major policies include the following:

1. AIDS/STD prevention and control program shall be implemented in all levels of STD service facilities.
   
   

2. Acceptable, affordable and effective case management of patients with STD shall be made accessible to all individuals through the general health care system, whenever possible.
   
   

3. Syndromic Management shall be applied when and where reliable laboratory diagnostic support is not consistently available.
   
   

4. Designated referral sites with appropriate laboratory support of STD diagnosis shall be made available at least on a regional level.
   
   

5. The Department of Health, in collaboration with the local government units, shall ensure that doctors, nurses, midwives, pharmacists, and other health care workers both hospital and community based, receive appropriate training on STD case management.

Implementing guidelines are hereby set to provide directions and instructions for STD case management at the different levels of health care system from tertiary hospitals down to the barangay health stations.

1.   Considerations for Provision of Care/Treatment

1. The definition of care in this level is that which is given at the first encounter between health care worker and clients where physical examination of clients cannot be performed or waived but not inhibited and STD laboratory facilities are neither available nor feasible.
   
   

2. Care provided shall be limited to 4 syndromes namely: urethral discharge, vaginal discharge, genital ulceration and neonatal conjunctivitis. Priority for provision of management shall be focused on vaginal discharge and urethral discharge.
   
   

3. Providers in this level shall not attempt management of complaints of testicular swelling and abdominal pain. Clients with these complaints shall be referred to the next higher level as soon as possible.
   
   

4. Management of STD clients shall be under the supervision of a medical staff.
   
   

5. The main function at this level is to provide adequate STD information and education campaigns to improve symptom recognition of clients and prevent future risk taking behavior.

2.   Area of Coverage/Recipient

1. Care at this level is appropriate in barangay health stations, rural health units and other facilities where primary health care is administered.
   
   

2. This is appropriate, where no local restrictions apply, to care given as a result of a home visit or informal care given at pharmacies and other drug dispensing outlets. Care given in this instance may be a result of complaints by a client, an incidental finding by a provider or a result of risk assessment.

3.   Referral Mechanism

1. Clients not responding to treatment at this level shall be referred to designated Social Hygiene Clinic, secondary health care level or referral center, where a laboratory is available to perform the basic laboratory tests to diagnose most STDs.
   
   

2. Clients with lower abdominal pain or scrotal swelling shall be referred immediately to the secondary health care level.

1. The definition of care in this level is that which is given at the first encounter between health care worker and clients where physical examination of clients including speculum and bimanual vaginal examination is possible but STD laboratory facilities are neither available nor feasible.
   
   

2. Care provided shall include all 6 syndromes namely: urethral discharge, vaginal discharge, genital ulceration, lower abdominal pain, scrotal swelling and neonatal conjunctivitis. Priority for provision of management shall be focused on vaginal discharge, urethral discharge and lower abdominal pain.
   
   

3. Some personnel such as midwives and paramedical staff will be limited to provide care only in their field of expertise and shall not manage clients with lower abdominal pain and scrotal swelling unless the supervision of an attending medical staff is available.

3. STDs for Special Groups

1.   Considerations for Provision of Care/Treatment

1. The definition of care is that which is given at the first encounter between health care provider and client from a special population group such as commercial sex workers and other groups that from time to time the National AIDS/STD prevention and control program shall deem advisable to provide with special STD management. In this level the requirement for a physical examination of the client, including the use of speculum and bimanual vaginal examination is required. Simple STD laboratory facilities are usually available (gram staining, NSS and KOH preparation). This level usually performs simple STD laboratory diagnosis.
   
   

2. Care provided by personnel shall include simple STD laboratory diagnosis and all 6 syndromes namely: urethral discharge, vaginal discharge, lower abdominal pain, scrotal swelling, genital ulcers and neonatal conjunctivitis.

4. Secondary Health Care Level and Referral Centers

1.   Considerations for Provision of Care/Treatment

1. The definition of care is that which is given at the first encounter between health care provider and client and those referred from other health facilities for diagnosis and treatment support. In this level, the requirement for a physical examination when indicated is necessary. STD laboratory facilities are usually available such as gram staining, NSS and KOH.
   
   

2. Care provided by personnel shall include STD laboratory diagnosis and all 6 syndromes namely: urethral discharge, vaginal discharge, lower abdominal pain, scrotal swelling, genital ulcers and neonatal conjunctivitis.
   
   

3. Performs periodic studies of culture and sensitivity of Neisseria Gonorrhea to monitor effectiveness of treatment regimens. Conduct STD prevalence and special studies on STD.

5. Tertiary Level

1.   Considerations for Provision of Care/Treatment

1. The definition of care is that which is given at the first encounter between health care provider and client and those referred from other health facilities for diagnosis and treatment support. In this level, the requirement for a physical examination when indicated is necessary. STD laboratory facilities are usually available such as gram staining, NSS and KOH.
   
   

2. Care provided by personnel shall include STD laboratory diagnosis and all 6 syndromes namely: urethral discharge, vaginal discharge, lower abdominal pain, scrotal swelling, genital ulcers and neonal conjunctivitis.
   
   

3. Performs periodic studies of culture and sensitivity of Neisseria Gonorrhea to monitor effectiveness of treatment regimens. Conduct STD prevalence and special studies on STD.

ROLE/NATURE OF DOH ASSISTANCE

1. Provide technically sound recommendations as the need arises to improve STD case management at all levels of health care.
   
   

2. Provide training of trainers on STD case management.
   
   

3. Develop standardized training modules and materials.
   
   

4. Monitor and conduct evaluation of the quality of STD case management and training.
   
   

5. Augment financial support to the local government unit or provide recommendations for the sustainability of activities for the government unit or provision of STD services at the local government units.
   
   

6. Advocate to policy makers, local government units the importance of providing adequate STD services to generate resources, sustain the implementation of activities and develop local policies that are consistent with national policies.
   
   

7. Coordinate the implementation of activities at the different levels of health care system to ensure proper utilization of limited resources, prevent duplication of functions and render adequate referral mechanism.